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23C-056 (3) AC O® DATE(MMIDDfYYYY) C E RTI I-I CAT E OF LIABILITY INSURANCE 1/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSUPilkNCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND 1'HE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIT1014AL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,ceutain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Cynthia Henderson, CISR Webber & Grinnell PHONE (413)586_0111 FAX (413)586-6481 8 North King Street EMAIL rson@webberandgrinnell.com INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01068) INSURERA:Travelers Companies, Inc. INSURED INSURER 6:Cl tat ion 40274 Keiter Builders, Inc. INSURERc:Travelers Indemn. Co. CT 25682 51A Hatfield Street INSURER D: INSURER E: Northam ton MA 01060 INSURER F: COVERAGES CERTIFICATE NUNIBER:Exp 2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE: LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER FAIN, THE II4SURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDI..SUBR POLICY EFF POLICY EXP POLICY NUMBER (MMIDDIYYYYI IMM/DDtYYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 PREMISES(Ea occurrence)A CLAIMS-MADE aOCCUR 6806319N6611342 6/1/2013 6/1/2014 MED EXP(Any one person $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED CDR(,7 12/21/2013 2/21/2014 BODILY INJURY Per accident) $ AUTOS AUTOS ( ) X HIRED AUTOS X AUTOS WNED PROPERTY DAMAGE $ Per i n Medical payments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAJMS-MADE AGGREGATE $ DED RETENTION AG $ C WORKERS COMPENSATION X WC STATU- 'IT AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) IEUB2A56578213 6/11/2013 6/11/2014 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 L ] I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ***** For Information Only ****'k ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE B Grynkiewicz/BARBG ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD I T Em own"W& NIB UILDERS ' SCOPE OF WORK MAY 08, 2014 CUSTOMER NAME: Wendy & John Sinton ADDRESS: 124 Willow Street,Florence, MA ESTIMATED START DATE: Summer,2014 ESTIMATED PROJECT RUN TIME: 3 —4 Days ADMINISTRATION ■ Keiter Builders,Inc. will manage the following aspects of the project: • Building permit application • Standing all necessary inspections • Materials ordering and! delivery • Site set-up and break-down • Certificate of Occupancy WINDOWS (Please see attached r.k. Miles Quote # RVDE2LG for window specifications) This proposal includes the following: • Permit application, fees, and. inspections. • Installation of(7) new construction Integrity windows. This includes the following: • Demolition and debris removal • Staging and Equipment • Preparation of existing rough opening including new pan flashing • Installation of new construction units to manufacturer specifications • Installation of all weather sealants and low expansion foam insulation • Installation of 3M flashing tape around window perimeter • Cut back existing siding and re-nail to accommodate new 5/4" flat stock Boral trim • Installation of new 1 '/4" white aluminum drip cap • Installation of new interior, pre-primed pine colonial 2 ''/z" casing • Please note that the following are not included in this contract: Any painting, nail hole filling, stain, polyurethane, or other finishes. It is possible that new trim may not cover paint lines. PRICE FOR WINDOWS (Including'Tax): $5,132.53 PRICE FOR PERMIT, MISCELLANEOUS MATERIALS, AND LAB OR: $3,650.00 TOTAL PRICE FOR LABOR AND MATERIAL $8,782.53 �i ,. /� .,� `� f z of conservation commissions, are required to be obtained before Keiter Builders, Inc. can obtain their permits, it is your obligation to satisfy such requirements and you shall meet those requirements at your cost. STARTING AND ENDING DATES: Keiter Builders, Inc. will apply for the permits within 30 day(s) of signing this Agreement or your satisfying any conditions required to be met prior to the permits being used, whichever date is later. Keiter Builders, Inc. will start work within 30 day(s) of obtaining the necessary permits and expects to have the work substantially completed within 5 day (s) of starting. If Keiter Builders, Inc. is delayed at any time, in the progress of completing the work, due to acts of God, war, civil commotion, accident, government regulations or policies, any act or neglect of yours, or by any separate contractor, or by change orders, or by labor disputes, fire, delay in transportation, unavailability of materials, adverse weather conditions, unavoidable casualties, difficulty in obtaining fuel, electricity, services or supplies from the sources from which they are normally obtained, or other causes reasonably beyond my control, then Keiter Builders, Inc. may reasonably extend the date for substantial completion. If the work is not substantially complete by the ending date, as extended, Keiter Builders, Inc. will not be liable to you for any incidental or consequential damages you may incur due to such delay. If you are supplying any materials or equipment to be used in the work, you shall have such materials and equipment delivered to the work site not less than 5 days before they are needed for the work. If they are not delivered on a timely basis, Keiter Builders, Inc. will not be able to schedule work dependent upon them and the date of substantial completion will be extended due to such delay. TOTAL PRICE AND PAYMENT SCHEDULE: The total price for performing the work and supplying the materials under this Agreement is Eight thousand, seven hundred and ei ht two dollars and fifty three cents ($8,782.53) DOLLARS. Payments against work completed and materials delivered will be made within 2 days from when Keiter Builders, Inc. notifies you that they have reached different completion stages. Payments will be made in the amounts as set forth in the attached payment schedule. 60% of window cost due with signed contract ($3,079.52) 40% of window cost+ 1/3 labor & misc. material due prior to initiating work ($3,269.68) Final payment due at Substantial Completion. ($2,433.33) All sums not paid before substantial completion of the work will be due and payable upon substantial completion. Payments due and unpaid under this Agreement shall bear interest from the date payment is due at the annual rate of Eighteen (18%) percent or at the maximum legal rate whichever is less. In the event that Keiter Builders, Inc. incurs costs or expenses in collecting any payments due and unpaid under this Agreement, you shall pay such costs and expenses including reasonable attorney's fees. If you fail to make any payments when they are due, then Keiter Builders, Inc. may immediately stop work. Keiter Builders, Inc. may choose to not start work again until you are current with the payments and Keiter Builders, Inc. feels secure in obtaining the remaining payments. If there is any stoppage in work due to your failure to pay on time, or to make Keiter Builders, Inc. feel insecure that the remaining payments will be made, such delay shall automatically exte'nd the (late of substantial completion. 2 CONSTRUCTION AGREEMENT Keiter Builders, Inc., of Northampton, MA whose Federal Tax Identification Number is 27-2518846, Contractor's Registration Number 175168 (Exp. 04-29-2015), and License 4102457 (Exp. 06-20-2014), is entering into this Agreement with you John & Wendy Sinton of 124 Willow Street, Florence MA. ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS ARE REQUIRED TO BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION, ONE ASHBURTON PLACE, ROOM 1301, BOSTON, MA 02018 (617) 727-8598. SCOPE OF WORK: Keiter Builders, Inc. will perform the work set forth in the attached Scope of Work on your home, or the property located at 124 Willow Street, Florence, MA. If you would like to change any work to be performed or materials used, we will have to make such changes through a Change Work Order, which may also change the total price and extend the date for completion. Change Orders will be handled on a time and material basis. Keiter Builders, Inc. reserves the right to make minor changes in any plans and to substitute materials of equal or better quality. Should Keiter Builders, Inc. encounter any unknown conditions below the surface of the ground, or concealed or unknown conditions in any existing structure, you will agree to make an equitable adjustment with Keiter Builders, Inc. under a Change Work Order, which shall increase the total price and extend the date for substantial completion of the work. PERMITS: To perform this work, Keiter Builders, Inc., or subcontractors hired by Keiter Builders, Inc., will obtain, on your behalf, the following permits (if required): X.— Building Permit — Electrical Permit Smoke Certificate Plumbing Permit _ Demolition Permit Certificate of Occupancy IT IS THE OBLIGATION OF IKEITER BUILDERS, INC. TO OBTAIN THESE PERMITS AS YOUR AGENT. IN THE EVENT THAT KEITER BUILDERS, INC. DOES NOT OBTAIN THESE PERMITS, AND YOU OBTAIN THEM, OR IF KEITER BUILDERS, INC. IS NOT REGISTERED WITH THE BOARD OF BUILDING REGULATIONS, YOU WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 142A. Keiter Builders, Inc. obligation to obtain permits is limited to those permits directly related to performing the work Keiter Builders, Inc. agrees to do. To the extent that other permits or governmental or regulatory agency approvals, such as, but not limited to, zone changes, variances, special permits, site plan approvals, or approvals .CITE' OF NORTHAMPTON i\ Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work. - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 14 ariieusiass(O>gartYZatio %Ind>� clual) I� ►�G, Gtr%Su te'%Z>p: rtbY"C-P- MA- 0(0(0 2 Phone, #: e60*r?! Wtihifatopidprlit6,boir: pie T.ypi;�bf�pro j[C ����rti�eil) 1. I am an employer with__q_ 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. ❑ Remodeling listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- These sub-contractors have 8.1 Demolition ship and have no employees employees and have workfrrs' 9 ❑ Building addition working for me in any capacity. comp. insurance.$ [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers have exercised their 11.❑ Plumbing repairs or additions 3. ❑ I am a homeownerSeattle8 doing right of exemption per MGL c. 12.❑ Roof repairs all work myself. [No workers' 152, §1(4),and we have no comp. insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information ,, // Insurance'Gomjariyame ✓Gl V�.c-e V 5 S�t VGtiYi C-� Policy#>`or'Savi s' I;ic:#, T�U$2 fl i&5-7?- � a- Expiration Date & - YoM7fet1`Zliesrs'All Locations 1,;7,q k/, Ci�'fStfe/Zi / ,t�f ) �7<, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eek,ify un er the pains and penalties of perjury that the information provided above is true and correct Signature;' Phone# - !o - (ron Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License#: Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other: Contact Person: Phone#: ZAWorkers Comp Aff-Highlited.doc SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: S n)4+ e-e- 1 4'e-V- C /b Z 4- 7 License Number It �G OAP-6 0 A-- 61W 4�,-Zo Add r ss Expiration Date 4610 ig p ure r Telephone 9.Reaistered Home Improvement Contractor: Not Applicable ❑ Company/Name 0 L Is A Registration Number MA-6 tupo - Address Expiration Date T'e(ep SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ,�[ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[o] Other[O] Brief Description of Proposed I-Q,� Work: /�i d Alteration of existing bedroom Yes \4 No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 50( &V-"5 as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are trIle and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. SCOTT Kra I f_► Print Name Sig ure of Own r/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: _ L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW fiD YES 0 IF YES, date issued:` IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ey DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,exc tion, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES l NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Depart ent use only _.., . City, f orthampton Status of Permit: JUG — 2 2omBuilo Department Curb CuOriveway Permit 212 ain Street Sew erfaeptic Auall6bility Electric, Pwmb .c -� �, inspecti�i m 100 Water/Well AvailaW if)t MA on, MA 01060 Two Seta"of Structur=al Flans. phone 413-587-1240 Fax 413-587-1272 PiaUSite:Ptarts'. Other specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit C-� M A- D I6 62 Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: I&f-e v Bur ld-e r6 - at+- 4e v- 3jr 1�7 >tr' r� S�- FGatle4 lrt V A4 lokz Na (Pr nt) Current Mailing Address: -4� U6 i ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building q Q� (a)Building Permit Fee 2. Electrical O O (b)Estimated,Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= 0 +2 +3+4+5) SSZ -.53 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 124 WILLOW ST BP-2014-1280 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23C-056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:window replaced BUILDING PERMIT Permit# BP-2014-1280 Project# JS-2014-002150 Est.Cost: $8782.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCOTT KEITER 102457 Lot Size(sa. ft.): 30796.92 Owner: SINTON WENDY W&JOHN W Zoning:URA(100)/W P(100)/WWP(29)/ Applicant: SCOTT KEITER AT. 124 WILLOW ST Applicant Address: Phone: Insurance: 5 1 A HATFIELD ST (413) 320-9035 WC NORTHAMPTONMA01060 ISSUED ON:61212014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 7 REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Date Paid: Amount: Building 6/2/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner